What we’ve said about Stimulants

“I do prescribe stimulants on the first or second visit, but I need medical evidence. I need enough evidence to say that the major problem that we're dealing with today is not mood disorder, not personality disorder, not self-regulation disorder, not a mismatch between the self and the environment”

“I think stimulants are going to improve your executive functioning, whether or not no matter where you fit on the bell curve, and that there are psychological tools and environmental changes that you can make that will decrease the symptoms you experience, again, no matter where you are on the bell curve”

“medications aren't going to solve all your problems. Medications might solve some of your problems if you have more of a biological problem. But it's just one part of your treatment”

“Before we start thinking about giving a stimulant, how about if we see if we can get you seven and a half hours of sleep and then we'll see what targets remain”

“The main exception for me is geriatric depression coupled with more apathy, abolition. That is probably a product of something more neurocognitive. You know, a little light dementia or even full dementia where there's a lot of abolition, apathy, low energy. Add a little stimulant. That's okay. There's something more neurobiological going on”

“A treatment is different than a drug, not because of the substance that it actually is or its properties. The difference is that when you take a drug, it gives you an effect, and when you don't have that drug, the effect goes away”

“there's a sense that the stimulant stops working in some sense or needs a higher dose after initially working for a few weeks, that's not the medication treatment effect. That's the drug effect. So do not fall for that trap”

“the stimulant helps you feel like that's not such a problem. for at least the first couple of hours when it's at a high level. But like I mentioned before, that's not treatment, right? That's a drug effect”

“There are diminishing returns. You need to differentiate between the energy boost in euphoria and the clinical treatment of ADHD”

“it is a drug, a stimulant drug that has habit-forming potential and basically creates tolerance pretty rapidly in most people who do not have ADHD”

“What you feel on a stim, on meth or cocaine or speed, which is what Adderall is, is an intoxicant effect. That is the euphoria and energy burst, and you will build tolerance to that”

“it doesn't treat depression in the long term. And what I've seen with so many patients who have ADHD plus depression is you're You're not treating the depression and you'll see irritability creep up. You'll see somatic symptoms creep up”

“It's symptomatic treatment. It doesn't seem to we don't see a lot of evidence for long term effects. Anyone that takes a stimulant will feel better. You take away that stimulant, they will feel more depressed. That's just kind of how they work and don't quite understand why”

“if you're treating a proper ADHD, the psychological anxiety reduction far outweighs It's the minor physiological. Physiological anxiety”

“especially in today's world where stimulants in the United States, at least, are probably highly overprescribed”

“I've just seen so many times patients with OCD, PTSD, anxiety on bupropion. You pull it off and they get better”

“do not be one of those providers who hears that the patient can't concentrate and put these people on stimulants i see it all the time”

“You can't forget the prescription medications that are being taken by patients that don't consider drugs, even if they are prescribed or are not prescribed to them. Obviously, the biggest ones are stimulants, but we also have to consider the possibility of antidepressant induced mania”

“I've had several patients where, uh, they had the childhood diagnosis of ADHD and yes, they began to develop a bipolar disorder in their early twenties. And, you know, if you're coming in and the only solution that you're aware of that anyone has told you about is a stimulant, that's going to be making things worse”

“once they're starting to turn 18 or in their 20s, they start developing stimulant-induced psychosis. Okay. And how do I know it's that? Because I pull them off the stimulants and the psychotic symptoms stop”

“methylphenidate, which there's at least some preliminary evidence showing is more suitable for use in bipolar disorders, though personally, I never give stimulants to bipolar disorder patients”

“There's going to be a higher risk of psychosis, mania, insomnia, weight loss, appetite decrease. Okay. And more importantly than even that small risk”

“we forgot to put limiting and timing stimulants onto the board. That's an S tier for sure. Go ahead and throw it on there. Stimulants, including caffeine, basically anything That produces wakefulness physiologically or suppresses sleep physiologically”

“for stimulants, it's really, really hard to subjectively know how a stimulant affects your sleep. Trust your gut. If a patient is drinking three espresso shots, please talk to them about the impact of five espresso shots before starting a sleep medication”

“that's why modern extended release stimulants are made to have a rising level Of the stimulant serum level in the afternoon period. So if you're getting a long-acting stimulant, XR, IR, XR, or whatever you call them, and you're feeling that, that's probably just what you're supposed to be feeling”

“how often do we see patients on higher and higher doses of stimulants? Patients who, you know, they're running through the gambit of different antidepressants because the persons were not thinking through the hierarchy appropriately”

“the biggest things that are ignored are trauma disorders, proper trauma disorders, not just people of history, trauma, um, What else is ignored is mood disorders, and the most harmful one to ignore is, of course, bipolar disorder”

“if we hide that behind a diagnosis, a medical diagnosis, and we have you push through it at the cost of your physical and mental health by putting you on essentially amphetamine speed, that's a detriment to your overall life, right”

“If you use a chemical defense, essentially, like in place of a psychological defense, you use exogenous chemicals in a manner where you're trying to rescue yourself from something or push yourself to some limit, that's a downward spiral”

“there is a financial incentive to diagnose ADHD. And there's a financial incentive to have a relatively loose diagnosis of ADHD. So, you know, primary care doctors, for example, if you have an ADHD patient, that's a patient that's going to come monthly”

“people want everyone on stimulants because they think it's a biological illness, right? If you thought that ADHD was purely a social construct, which, by the way, I don't actually believe, then you wouldn't medicate. You'd change the society”

“they just want the problem to be better fundamentally. And if you can orient towards that, regardless of what you're going to call it, even if you and the patient end up calling it two different things”

“I have to tell you, though, after just this one evaluation, I'm still not really exactly sure what you have. OK, I am hearing some evidence of possible ADHD type symptoms”

“I understand you really think that the medication is going to help you, but I don't really see any medical indication today. And so unfortunately, I'm not going to prescribe you anything”

“I'm not going to give any medications to anybody that are not clearly medically indicated. I don't want to give anyone anything inappropriate. And I think the best thing to do is if we can keep working together”

“stimulants are not something that it's not just a very safe medication that anyone can take. And I know you can go to another psychiatrist whenever you want, but I'd like to try to find out what this is instead”

“I know that you can go to another provider and get this diagnosis and get put on Adderall if you wanted to, but I'm worried about you. And I'm worried that, yes, maybe the Adderall will help you today and tomorrow, but these things have consequences”

“I think you need to dial back people who are in this situation and ask, what is important to me? What do I value? And what do I want my life to look like outside of work or outside of whatever I think these stimulants are going to do for me”

“you have to be okay with losing a few patients. And the way I formulated it, I was being considerate. It's not that I missed the diagnosis or I made a mistake. I wanted to make sure that I had the right diagnosis and I didn't just give a treatment to make it so that the patient kept with me”